A few months ago, I spent a considerable amount of time this past holiday season with my family. After a couple of glasses of wine, several of my aunts (who are all in their mid 60’s) began asking me questions about painful sex. One of my aunts relayed her recent experience to me, of being at her gynecologist’s office and told that she needed to start dilation. Her doctor told her that the pain was coming from a tight and short vaginal opening, and that she should search for dilators on the internet. She was embarrassed to be discussing this with her niece but did not know where else to turn. On one hand, I thought it was great that her doctor was addressing the issue of painful sex after menopause. As we unfortunately know, women’s sexual pleasure is often a marginalized discussion in what usually amounts to a 15-minute visit at the GYN office. On the other hand, I thought, how ineffective – to ask a mature woman in pain to go searching on “the internet” for such an intimate object, that requires careful instruction in its use. Women often don’t understand their anatomy, the changes that can occur in menopause, or what can be done about it. Pain with sex is often a hidden problem that most women avoid seeking treatment to overcome, due to shame. We need to better educate women throughout the life cycle about what changes they can expect to see in their bodies, and when to ask for help. They should not feel shame in asking.
With that said, I’d like to take a moment to clarify that painful sex can come in many different forms. Vaginismus, which is pain related to tight muscles at the vaginal opening (sometimes called introital pain) has two subsets – primary and secondary. Primary vaginismus is pain that has ALWAYS been present. Women who fall into this category have not usually been successful in inserting a tampon or having a speculum exam due to muscle spasms. This is often accompanied by anxiety and fear of any penetration. Secondary vaginismus occurs after women have experienced a healthy sex life, but for myriad reason may have significant pain with penetrative intercourse. This can be as a result of hormonal changes during menopause, post-surgical changes, medications, or trauma to name a few.
The diagnosis of vaginismus requires a pelvic exam, and an assessment of the muscles that surround the vaginal opening. If your medical provider determines you do have vaginismus, it’s likely that vaginal dilators will be indicated in your treatment plan. These dilators help progressively stretch the muscles, and eventually allow for comfortable penetration. Other treatments that may be indicated include hormonal therapies, pelvic floor physical therapy, and counseling. If you are suffering with painful sex or vaginismus, it is important you find a healthcare provider that is skilled, knowledgeable and equipped to treat these conditions. Painful sex is never acceptable, and if you are told otherwise – find someone else who will listen. You deserve it.
If you are experiencing painful sex, please contact us for a free phone consultation.